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Simplified management of low-energy projectile extraperitoneal rectal injuries
Naveed Ahmed1, Sanjay Thekkeurumbil, Viney Mathavan
1Department of Surgery, Huron Hospital, East Cleveland, Ohio, USA. nahmed@cchseast.org
Introduction:
Since minimally invasive approach for fecal diversion in low-velocity extraperitoneal rectal injuries (EPRI) has a lower morbidity than open, and since computed tomography (CT) scan is helpful in ruling out concomitant intraperitoneal injuries (IPI), we utilized both modalities to simplify management of such injuries.
Methods:
Retrospective review of stable patients with EPRI, treated with laparoscopic assisted diversion, after a CT scan, compared with patients with similar injuries that had a negative laparotomy and a colostomy.
Results:
The laparoscopy group had a shorter length of stay (3 +/- 2 days versus 7 +/- 2 days), earlier return of bowel function (3 +/- 2 days versus 5 +/- 2 days) and fewer infectious complications. If the CT scan was negative for IPI, none were found on open exploration or laparoscopy.
Conclusion:
If IPI are ruled out with a preoperative CT scan, laparoscopy-assisted colostomy is safe and less morbid.
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